Evidence-based prior authorization support

A smarter way to navigate pharmacy decisions

Prior authorizations are common when managing workers’ compensation claims. These important clinical decisions must consider the latest medication formularies, treatment guidelines, health risks, drug utilization trends, and state-by-state legislative activities to help ensure an injured worker’s pharmacy treatment is safe, effective, and at the right cost.

The MyMatrixx solution to this is our real-time, evidence-based prior authorization support that sits within our MyPassport® portal. This easy-to-use tool is like having a pharmacist sit at your desk, and it empowers claims professionals with information to transform complex pharmacy authorizations into clear, actionable decisions.

Powerful rules engine sourced from over one million rules

Our comprehensive decision support is sourced from over one million rules gathered from state formularies, clinical guidelines, industry references and proprietary algorithms. This tool evaluates appropriateness for over 270,000 medications based on jurisdictional guidelines, clinical best practices, and injury type.

Accessible icons and decision rationale provide one-click access to information

Presented prominently on the MyPassport authorization screen, accessible icons provide insight into the medication and in one click you'll have access to information to help you make a quick, evidence-based decision. Information that highlights:

• High-cost outliers
• Formulary status
• Clinical risks (e.g., opioid alerts)
• Generic substitution opportunities
• Alternative medications
• Compounds

MyMatrixx real-time decision support helps you:

Reduce Delays: Expedite prior authorization decisions with confidence.

Improve Outcomes: Align medication choices with clinical and regulatory best practices.

Control Costs: Identify high-cost drugs, suggest lower-cost alternatives or generics, and trigger additional clinical intervention.

Enhance Compliance: Stay aligned with state-specific formulary rules and injury-based guidelines.

Support Adjusters: Equip your team with a reliable, easy-to-use tool that simplifies complex pharmacy decisions.